BACKGROUND:Higher short-term blood pressure (BP) variability (BPV) can reflect impaired autonomic regulation of BP in response to postural change and physical activity, which could precipitate falls through transient cerebral hypoperfusion and loss of postural stability. We hypothesized that higher short-term BPV assessed by ambulatory BP monitoring (ABPM) would be associated with an increased risk of falls. METHODS:This prospective study examined the association between BPV assessed by ABPM and fall risk among community-dwelling adults aged ≥65 years with hypertension who were taking antihypertensive medication. Participants completed 24-hour ABPM; subsequently, they completed 12 monthly falls calendars. Systolic BPV was quantified as the standard deviation (SD) of 24-hour systolic BP (SBP) (SD24h-SBP), calculated from the weighted average of awake and asleep SD values. Cox proportional hazards models estimated hazard ratios (HRs) for time to first fall, comparing quartile 4 (Q4) with quartiles 1-3 (Q1-Q3) of SD24h-SBP. RESULTS:Among 608 participants (mean±SD age 74.6±6.2 years; 56.9% female), 238 (39.1%) reported a fall during the 12-month follow-up period. Falls occurred in 172/457 (37.6%) and 66/151 (43.4%) participants in Q1-Q3 and Q4 of SD24h-SBP, respectively. Participants in Q4 of SD24h-SBP did not have a higher fall risk than Q1-Q3 (adjusted HR [95% CI] 1.17 [0.86-1.58]). In analyses using the SDs of awake and asleep SBP, Q4 was not associated with fall risk compared with Q1-Q3. CONCLUSION:Twenty-four hour and awake BPV assessed by ABPM was not associated with fall risk among older adults taking antihypertensive medication.
BACKGROUND:Hypertension is the leading cause of preventable deaths worldwide, yet blood pressure (BP) control remains poor in Australia when compared to other similar higher income countries. This study aims to explore general practitioners' (GPs) perceptions of hypertension management and single pill combination (SPC) to identify barriers and facilitators to guideline implementation and SPC use in Australia. METHODS:Semi-structured interviews were conducted with 20 GPs (June-July 2024). Participants were purposively sampled to ensure diversity (age, sex, experience, location). Interviews explored diagnosis, treatment, monitoring, and attitudes toward guidelines and single pill combinations (SPCs). Transcripts were analyzed using a combined deductive-inductive approach guided by the Consolidated Framework for Implementation Research. RESULTS:GPs demonstrated limited awareness of recent international guideline updates and relied predominantly on the 2016 Australian guidelines, with most initiating treatment with monotherapy and targeting BP < 140/90 mmHg. SPCs were rarely used early and were perceived as difficult to titrate. Practice-level audits of BP control were absent, team-based care was inconsistently implemented. Therapeutic inertia and non-adherence to antihypertensive therapy-key barriers to BP control-were rarely acknowledged. Younger and academically affiliated GPs were more receptive to SPCs and lower BP targets, while experienced GPs often favored conservative, stepwise escalation partly due to concerns of side-effects. CONCLUSIONS:Whilst hypertension management in Australian general practice overall aligns with current national guidelines, an update to the 2016 guidelines is urgently needed to reflect best-evidence, particularly on the use of SPCs and strengthening of team-based care to improve BP control.
BACKGROUND:Excessive dietary sodium intake contributes to approximately five million deaths annually, mainly due to its association with hypertension and cardiovascular disease. However, healthcare providers have no practicable method to estimate the dietary intake of their patients. METHODS:We conceived and developed the Brief Office Sodium Screener (BOSS), a self-administered survey to be completed in three minutes. Using data from the National Health and Nutrition Examination Survey and U.S. Department of Agriculture Food Data Central, high sodium foods (those with ≥300 mg/serving) were compiled into a 30-item survey assessing both frequency and serving size. Automated scoring utilizes the median sodium content per serving, and the report estimates total sodium (mg/day) from high salt sources and the top three contributing items. From September 2023 to August 2024, patients at a tertiary hypertension clinic completed the BOSS and queries about the survey's usability and perceived accuracy during rooming. RESULTS:We included 131 patients; 43% were male, mean age 61 years, range 27-91), and 81% self-identified as white race. The median estimated sodium intake from high sodium foods was 1,699 mg/day (range 0-7,901 mg/day). Top sodium sources were poultry dishes, bread, pasta, and cheese. Among 118 patients who provided feedback, 85% found the BOSS easy to use, 96% felt it was somewhat, moderately or very accurate. CONCLUSIONS:The study provides evidence that the BOSS questionnaire is usable and efficient in estimating excessive sodium consumption during outpatient encounters.
Abstract Objectives To explore the framing effect of health promotion information on processes of change and decision balance among community residents in the context of primary prevention of hypertension. Methods A randomized controlled trial was conducted, enrolling 314 volunteers from Jiangchuan Community Health Service Center, Minhang District, Shanghai. Participants were randomly assigned to either a gain-framed group (positive framing, n = 159; information emphasized the benefits of ceasing unhealthy behaviors) or a loss-framed group (negative framing, n = 155; information emphasized the harms of engaging in unhealthy behaviors) using a random number table. Participants’ cognitive level (depth of information processing and problem-solving) and future orientation (attention to future outcomes when making decisions) were assessed. Processes of change and decisional balance were evaluated before and after the intervention, and stratified analyses were performed by sex, age, cognitive level, and future orientation. Results Both gain-framed and loss-framed interventions led to significant improvements in scores for processes of change (all P < .05). Regarding subdimensions, 8 dimensions improved in the gain-framed group, whereas 6 dimensions improved in the loss-framed group. Before the intervention, no significant difference was observed in decisional balance scores between the 2 groups [96.0 (88.0, 104.0) vs 98.0 (90.0, 106.0), Z = 1.459, P = .144]. After the intervention, decisional balance score was significantly improved in both groups (all P < .05), and was higher in the loss-framed group than that in the gain-framed group [102.0 (94.0, 110.0) vs 99.0 (91.0, 108.0), Z = 2.157, P = .031]. Stratified analyses by gender showed that both male and female participants exhibited significant improvements in scores for processes of change and decisional balance after intervention. Among different age groups, for people under 39 years old, both indicators (scores for processes of change and decisional balance) increased after intervention in gain-framed group, while only decision balance score improved after intervention in loss-framed group (both P < .05); for people aged 39-55 years, only score for processes of change improved after intervention in both groups (both P < .05); for people over 55 years old, both indicators increased after intervention in loss-framed group, while only score for processes of change increased after intervention in gain-framed group (both P < .05). Stratified analyses by cognitive levels showed that in subjects with low-cognition, only score for processes of change increased after intervention in both groups (both P < .05); in subjects with medium-cognition, only decisional balance score increased after intervention in loss-framed group, while both indicators increased after intervention in gain-framed group (both P < .05); in subjects with high-cognition, only score for processes of change increased after intervention in gain-framed group (P < .05), while there were no statistically significant changes in both indicators after intervention in loss-framed group (both P > .05). Stratified analyses by future orientation showed that in reality-oriented participants, both indicators increased after the intervention in both groups (both P < .05); in balance-oriented participants, there were no statistically significant changes in both indicators after intervention in loss-framed group (both P > .05), while both indicators increased after intervention in gain-framed group (both P < .05); in future-oriented participants, both indicators increased after intervention in loss-framed group (P < .05), while the change in the 2 indicators was not statistically significance in the gain-framed group (both P > .05). Conclusion The framing effect of health promotion information plays a significant role in the primary prevention of hypertension. Both gain-framed and loss-framed information can improve processes of change and decisional balance scores, but their effects are different: gain-framed information has a broader impact on processes of change across more dimensions, whereas loss-framed information has a more pronounced effect on decisional balance. The effectiveness of framing interventions varies by sex, age, cognitive level, and future orientation, suggesting that tailoring information framing according to target population characteristics may optimize health behavior promotion.
Objective To systematically investigate the association and dose-response relationship between the metabolic score for insulin resistance(METS-IR)and the risk of hypertension,using data from a prospective cohort study of Chinese adults.Methods A total of 4 866 adults without hypertension at baseline were enrolled from the 2009 China Health and Nutrition Survey(CHNS)and followed up for 6 years to observe new-onset hypertension.Multivariable logistic regression,restricted cubic spline analysis,and subgroup analyses were employed to comprehensively evaluate the relationship between METS-IR and hypertension risk.Results During follow-up,1 256 participants developed hypertension.Multivariable logistic regression analysis showed that METS-IR was an independent risk factor for hypertension.As a continuous variable,METS-IR showed a positive correlation with hypertension risk(OR=1.03,95％CI:1.02-1.05,P＜0.001).In quartile analyses,compared with the lowest quartile,the highest quartile of METS-IR was associated with increased hypertension risk(OR=1.73,95％CI:1.37-2.18,P＜0.001).Restricted cubic spline analysis confirmed a linear correlation between METS-IR and hypertension risk(Pnonlinear=0.388).Subgroup analyses indicated no significant interaction effects of sex,smoking,alcohol consumption,region,body mass index,or age on this association(all P＞0.05).Conclusion METS-IR serves as an independent risk factor for hypertension,with elevated levels demonstrating a positive correlation with hypertension risk.
BACKGROUND:We examined the association between blood pressure (BP) time in target range and clinical outcomes in chronic kidney disease (CKD). METHODS:In 1908 participants in the Chronic Renal Insufficiency Cohort study who had BP measured at each visit for the first five years of the study, BP time in target range was defined as the percentage of visits with BP < 130/80 mmHg between baseline and year 5; and categorized into three groups (<25%, 25% to 75% and >75% of visits in target). Outcomes included cardiovascular events, kidney outcomes and mortality occurring after the year 5 visit. RESULTS:BP was in target range < 25% of visits in 430 (22.5%) participants; 909 (47.6%) participants had BP in target range 25-75% of visits, and 569 (29.8%) participants had BP in target range > 75% of visits. Participants with BP in target range at < 25% of visits had higher risks of subsequent cardiovascular events (Hazard Ratio HR 1.76, 95% Confidence Intervals 1.28-2.41), kidney outcomes (HR 2.25, 1.66-3.05), and all-cause mortality (HR 1.54, 1.21-1.97) compared with those controlled at > 75% of visits Participants with BP in target range at 25-75% of visits had higher risks of subsequent cardiovascular events (HR 1.46, 1.12-1.89), and kidney outcomes (HR 1.55, 1.21-1.98), compared with those controlled at > 75% of visits. CONCLUSIONS:Participants with CKD with lower BP time in target range over a five year period had a higher risk of subsequent renal and cardiovascular outcomes.
BACKGROUND:Elevated nighttime blood pressure (BP), nocturnal non-dipping, and exaggerated morning BP surge (MBPS) are established risk factors for cardiovascular events. These diurnal BP variability patterns can be assessed by ambulatory BP monitoring (ABPM) but not by conventional home BP monitors. We aimed to examine whether home BP data are associated with these BP variability patterns. METHODS:Treated hypertensive participants in the HI-JAMP study underwent 24-hour ABPM followed by home BP monitoring (HBPM). Home BP was measured twice each morning and evening for 5 days using a multisensor device that also recorded room temperature. A total of 2,248 participants with complete ABPM and HBPM data were analyzed. RESULTS:Among 2,248 participants, ABPM-defined nocturnal hypertension was present in 679 (30.2%), exaggerated MBPS in 171 (7.7%), and nocturnal non-dipping in 969 (43.1%). Of these, 39 participants (1.8%) had both nocturnal hypertension and exaggerated MBPS. Nocturnal hypertension, exaggerated MBPS, and non-dipping were each associated with elevated morning home systolic BP (SBP) of ≥ 135 mmHg measured by HBPM (odds ratios: 3.76, 2.00, and 1.33, respectively). Nocturnal hypertension (odds ratio: 1.84) and non-dipping (odds ratio: 1.69) were associated with higher room temperature, whereas exaggerated MBPS (odds ratio: 1.86) was associated with lower room temperature, independent of elevated morning home SBP. CONCLUSIONS:Individuals with high morning home BP were more likely to show abnormal diurnal BP variability. Incorporating room temperature into home BP assessments may provide additional context when interpreting home BP measurements. CLINICAL TRIAL REGISTRATION:University Hospital Medical Information Network Clinical Trials Registry, UMIN000029151 (HI-JAMP study).
BACKGROUND:Longitudinal findings on the relationship between sex, aging and left ventricular (LV) geometric patterns in population-based cohorts with a low prevalence of risk factors, are still scarce. We investigated this issue in the participants of the third survey of Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study in which echocardiographic data were prospectively collected over a 25-year period. METHODS:420 participants who attended the initial survey (1990-1993) and two subsequent ones, 10 (2001-2003) and 25 years later (2017-2018), were included in the analysis. LV geometric patterns were defined according to American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) guidelines. RESULTS:The prevalence of LV concentric geometry (i.e. relative wall thickness ≥ 0.43) increased progressively across the three surveys in both men: 11.5 (CI: 7.8-16.7), 29.0 (CI: 23.1-35.6), 53.0% (CI: 46.1-59.8), p < 0.001 and women: 5.5 (CI: 3.1-9.3), 14.9 (CI: 10.5-19.8), 36.8% (CI: 30.7-43.4), p < 0.001. Contrary to what found for other patterns, the prevalence of concentric LV hypertrophy (LVH) showed a different sex-specific behaviour, i.e. a gradual increase in women from the first to the third survey: 1.4 (CI: 0.5-2.4), 5.0 (CI: 2.8-8.3), 13.6% (CI: 9.7-18.8), p < 0.001) and a decline from second to third survey in men: 0.5 (CI: 0.1-2.8), 9.0 (CI: 5.8-13.9), 7.5% (CI: 4.6-12.0), p < 0.05). CONCLUSIONS:Our findings show that aging is accompanied by a marked increase in concentric geometry in both sexes, and suggest that women are at higher risk of developing concentric LVH.
BACKGROUND:Inflammation is one of the mechanisms of renal disease development in salt-sensitive hypertension (SS-HTN). We have previously shown that Dahl SS rats exhibit higher renal histamine levels when fed a high salt diet and reported that renal epithelium has abundant histaminergic system components. We hypothesized here that inhibition of histamine N-methyltransferase (HNMT) attenuates the development of hypertension and reduces renal damage in the Dahl SS rat. METHODS:Male Dahl SS rats implanted with telemeters were administered HNMT inhibitor SKF-91488 (3.0 mg/kg/day) or vehicle s.c., while fed a 4.0% NaCl high salt diet for 21 days. Renal function and biometric parameters were assessed at endpoint; tissues were collected and subjected to IHC and Western blotting. RESULTS:We report attenuation of hypertension in the SKF-91488 treated group at endpoint (mean arterial pressure = 132.6 ± 11.8 vs. 160.3 ± 6.5 mmHg in control, p < 0.05) and proximal tubule damage measured with KIM-1 (0.8 ± 0.1 vs. 1.7 ± 0.2% stained area fraction, p < 0.01). αSMA IHC of coronary vasculature in the SKF-91488 group demonstrated smaller vessel wall thickness relative to total diameter (p = 0.046). Renal abundance of histamine receptors 1 and 4 (p = 0.01/both) and the pan-macrophage marker CD68 (p = 0.04) were higher in the renal cortex of the SKF-91488 treated group. Urinary Cl- excretion was higher in the SKF-91488 treated rats at endpoint compared to vehicle controls (p < 0.001). CONCLUSIONS:Our study demonstrated that HNMT inhibition alleviates blood pressure and proximal tubule damage in SS-HTN, potentially through immune-related mechanisms.
BACKGROUND:Intensive blood pressure (BP) lowering increased acute kidney injury risk, despite cardiovascular benefits. We investigated the association between treatment-induced BP changes and kidney function decline, while accounting for arterial stiffness. METHODS:This post‑hoc analysis included 266 patients with hypertension from a 20‑week double‑blind trial treated with calcium-channel blockers. Kidney dysfunction was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min·1.73 m2 or a decrease ≥30% from baseline. Arterial stiffness was measured as brachial-ankle pulse wave velocity (baPWV). RESULTS:At baseline, systolic/diastolic BP (mean±SD, 153.2±9.3/91.8±9.5 mmHg) was associated positively (r = 0.20 [95% CI, 0.09 to 0.32]/0.23 [95% CI, 0.11 to 0.34]) with serum creatinine (72.1±16.2 μmol/l), and inversely (r=-0.25 [95% CI, -0.36 to -0.14]/-0.16 [95% CI, -0.28 to -0.04]) with eGFR (91.6±13.8 ml/min·1.73 m2). The associations with clinic systolic BP were weakened with higher baPWV, being observed in tertiles 1 and 2 (r ≥ 0.30 or ≤-0.27), but not tertile 3. After 20 weeks treatment, the incidence of kidney dysfunction was 0%, 4.8%, and 6.4%, respectively, in tertiles 1, 2 and 3 of baPWV (odds ratio for tertile 3 versus tertile 1, 2.23 [95% CI, 0.84-5.95]). In longitudinal analysis, the least square mean change from baseline in eGFR was -3.7 ml/min·1.73 m2 (95% CI, -4.3 to 1.1) in patients within tertile 3 of both baseline baPWV and treatment-induced clinic systolic BP changes. CONCLUSIONS:In patients with stiffer arteries, kidney function at baseline was not associated with higher BP, and its decline during follow-up was greater when clinic BP was intensively reduced.
Abstract Background This study aims to evaluate the mediating effects of body mass index (BMI) on the association between obstructive sleep apnea (OSA) and hypertension using a two-sample multivariate Mendelian randomization (MR) study method. Methods Summary statistics from publicly available genome-wide association studies were used for univariate and multivariate MR analyses to estimate the causal relationships and mediating effects of BMI. The inverse variance weighted (IVW) method was used as the main method for effect estimation, with additional methods including weighted median (WME), weighted mode (WM), MR-Egger regression, and the simple mode method (SM). Heterogeneity and pleiotropy in the study were assessed using the IVW method and pleiotropy residual and outlier analysis in Mendelian randomization (MR-PRESSO). Results The odds ratios (ORs) from univariate MR analyses regarding OSA and BMI on hypertension were 1.291 (95% CI: 1.111-1.500) and 1.981 (95% CI: 1.841-2.132), respectively. The multivariable MR analysis showed that the odds ratio for the association between OSA and hypertension was 1.051 (95% CI: 0.943-1.173). Further analysis indicated that BMI played a mediating role in the relationship between OSA and hypertension, with a mediation effect of 0.09 and a proportion of 34.6% (Sobel-test, P < .001). Conclusion OSA is a risk factor of hypertension, and BMI has a mediating effect on the association.
Abstract Background To explore the correlation between triglyceride glucose body mass index (TyG-BMI) and nocturnal ambulatory blood pressure parameters in the nocturnal hypertension (NH) population. Methods A cross-sectional study design was adopted. A total of 1,301 patients with NH attending the Hypertension Department of TEDA International Cardiovascular Disease Hospital between January 2020 and March 2023 and the Hypertension Department of Tianjin Kanghui Hospital between September 2023 and April 2025 were selected as the study subjects. The patients’ data were collected, and the TyGBMI was calculated. The patients were grouped into quartiles according to TyG-BMI. A generalized linear model was applied to analyze the association between TyG-BMI groups and nocturnal ambulatory blood pressure parameters. Stratified analyses were conducted according to age, gender, smoking status, alcohol consumption, and enrollment period. A restricted cubic curve (RCS curve) was drawn to analyze the correlation between TyG-BMI and the occurrence of target organ damage in patients with NH. Results The mean age of the total population was 47.75 ± 13.55 years old, and the mean TyG-BMI was 243.17 ± 42.31. The differences of the mean nocturnal systolic blood pressure, mean nocturnal diastolic blood pressure, and mean nocturnal heart rate among the 4 groups were statistically significant (P < .05). The results of the generalized linear model showed that after correcting for confounders, compared with the first quartile group, the nocturnal systolic blood pressure, nocturnal diastolic blood pressure, and nocturnal heart rate were higher in the highest quartile group of the TyG-BMI by 5.14 mmHg (95% CI: 2.65-7.62, P < .001), 3.99 mmHg (95% CI: 2.18-5.80, P < .001), and 2.46 beats/min (95% CI: 1.06-3.85, P < .001). Sensitivity analyses were conducted after excluding individuals aged ≥ 60 years (n = 1 014) and those with diabetes (n = 1 109), yielding results consistent with the primary analysis. The results of subgroup analyses showed that there was an interaction between different subgroups of TyG-BMI and age, gender, smoking, and alcohol consumption (all P < .05). In the < 45-year-old and female populations, the nocturnal systolic blood pressure was more significantly elevated in the higher tertile groups of TyG-BMI, which were 7.11 mmHg (95% CI: 3.78-10.43) and 8.93 mmHg (95% CI: 4.29-13.56), respectively. Restricted cubic plots showed a nonlinear correlation between TyG-BMI (Poverall = 0.017, Pnonlinear = 0.011) and risk of target organ injury in the NH population. Conclusion In NH patients, TyG-BMI showed a positive correlation with nocturnal ambulatory blood pressure levels. Compared with the first quartile, the increase in mean nocturnal systolic blood pressure was greater in the highest TyG-BMI quartile among those aged < 45 years than in those aged ≥ 45 years. Furthermore, the increase in nocturnal systolic blood pressure was higher in the highest TyG-BMI quartile groups among female patients than in male patients.
BACKGROUND:There is little information about systemic hemodynamic changes in the evolution of heart failure (HF) from hypertension. METHODS:We compared 24-hr mean hemodynamic variables derived from ambulatory pulse wave analysis (Mobil-O-Graph) in at-risk patients with hypertension (Stage A/B HF) and patients with Stage C HF secondarily stratified by ejection fraction (EF: low <40% or high ≥40%). RESULTS:Differences (mean ± SEM) between Stage A/B (n = 109) and Stage C HF (n = 52) were, respectively: stroke volume index (SVI) 36.8 vs. 31.9 mL/m2 (P<.001), heart rate (HR) 68.1 vs. 76.4 bpm (P<.001), and arterial stiffness (pulse pressure/SVI) 1.47 vs. 1.65 mmHg/mL/m2 (P<.05); cardiac index and total vascular resistance index did not differ between groups. Robust inverse correlations between SVI and HR were found in both Stage A/B and Stage C HF (P < .001); each 10 beat/min change in HR was accompanied by a reciprocal SVI change of 3 mL/m2; overall, SVI was 5-10% lower in Stage C compared to Stage A/B HF. Hemodynamic profiles, especially high HR and low SVI, were quantitatively similar in Stage C HF patients with low or high EF. Low SVI (<35 mL/min/m2) conferred a specificity for Stage C HF of 71%; adding high HR (>75 bpm) increased specificity to 84%. CONCLUSIONS:Ambulatory hemodynamic monitoring is feasible in HF patients; low 24-hour SVI and high HR are highly correlated and together can differentiate Stage C from Stage A/B HF, irrespective of EF. Further study of hemodynamic profiles in HF staging and prognosis is warranted.
BACKGROUND:Longitudinal data on seasonal variations in nighttime blood pressure (BP) obtained through home blood pressure monitoring (HBPM) are scarce. We examined whether nighttime BP is elevated in summer compared to winter in patients undergoing hypertension treatment. METHODS:Nighttime BP was measured for seven days using an HBPM device in 419 participants at baseline, and 136 of those underwent follow-up nighttime BP measurements at 6 months without any modification of antihypertensive therapy. Morning BP was also measured in some participants. RESULTS:The baseline cross-sectional analysis indicated that nighttime systolic BP was elevated in summer compared to winter (adjusted mean difference, 8.3 mmHg; 95% confidence interval [CI], 4.7-11.8). The longitudinal analyses revealed that nighttime systolic BP was higher in summer than in winter among winter-to-summer participants (mean difference, 5.1 mmHg; 95% CI, 3.1-7.0; n = 36) and among summer-to-winter participants (mean difference, 2.6 mmHg; 95% CI, 0.3-5.0; n = 23). Conversely, morning systolic BP was lower in summer than in winter among winter-to-summer participants (mean difference, 3.8 mmHg; 95% CI, 0.7-7.0) and among summer-to-winter participants (mean difference, 3.7 mmHg; 95% CI, 1.0-6.4). In sensitivity analyses, seasonal variations in room temperature were positively correlated with changes in nighttime systolic BP (r = 0.43; 95% CI, 0.21-0.60) and negatively correlated with changes in morning systolic BP (r=-0.46; 95% CI, -0.63 to -0.25). CONCLUSIONS:Nighttime systolic BP increased from winter to summer in association with higher room temperature and exhibited an inverse seasonal pattern compared to morning BP.
BACKGROUND:Blood pressure (BP) time in target range (TTR) predicts cardiovascular disease (CVD) in high-risk populations; however, TTR's predictive utility in older adults without prior CVD is uncertain. METHODS:We performed a post-hoc analysis of the ASPirin in Reducing Events in the Elderly trial and its observational follow-up. Systolic BP TTR for <140 and <130 mmHg was estimated for each participant using BPs from the first three visits. Participants with 0% or 100% TTR were categorized separately, and remaining participants grouped into tertiles using linear interpolation to estimate TTR. Cox proportional hazards models evaluated associations between TTR and adjudicated incident CVD and major adverse cardiovascular events (MACE) after the TTR estimation period, with 0% TTR as reference. RESULTS:Among 16,730 predominantly white Australian adults (mean age, 74 years) followed for a mean of 7.7 years after TTR estimation, 100% TTR <140 mmHg had reduced risk of CVD (HR, 0.81 [95% CI, 0.68-0.96]; P = .01), while 100% TTR <130 mmHg had reduced risks of CVD (HR, 0.82 [95% CI, 0.67-0.99]; P = .04) and MACE (HR, 0.72 [95% CI, 0.57-0.91]; P < .01). Associations were strongest among women, antihypertensive users, frail/pre-frail participants, and those younger than median age. Findings were consistent after adjusting for competing risk of non-CVD death, when the TTR estimation period was extended an additional year, and when estimated using proportion of individual visit BPs at target. CONCLUSIONS:Longer systolic BP TTR was associated with reduced risk of cardiovascular events in older adults, underscoring the importance of sustained BP control with aging.
BACKGROUND:Arterial stiffness (AS), a key cardiovascular disease (CVD) risk factor, arises from structural stiffening due to arterial remodeling and load-dependent stiffening from elevated blood pressure (BP). However, their contributions to CVD risk and the mediating role of hypertension remain uncertain. We aimed to quantify the associations of AS components with incident CVD and assess hypertension's mediating effects. METHODS:Among 12,684 Kailuan cohort participants, AS (measured via brachial-ankle pulse wave velocity [baPWV]) and hypertension were assessed at baseline (2010-2014). The exposures were four AS components: measured, total, structural, and load-dependent stiffness. Total stiffness was derived from measured baPWV and concurrent BP. Structural stiffness was calculated by adjusting total stiffness to a reference BP (120/80 mmHg) using participant-specific models, with load-dependent stiffness defined as the residual. Cox models evaluated associations between AS components and incident CVD. Mediation analysis decomposed each component's total effect into direct and hypertension- mediated indirect effects. RESULTS:Over a median follow-up of 11.35 years, 803 CVD events occurred. Each 1-SD increase in AS components was associated with higher CVD risk, with adjusted hazard ratios (95% CIs) of 1.21 (1.14, 1.29) for measured, 1.20 (1.13, 1.28) for total, 1.17 (1.10, 1.25) for structural, and 1.20 (1.11, 1.30) for load-dependent stiffness. Hypertension mediated 48.7%, 50.6%, 24.0%, 75.9% of these associations for measured, total, structural, and load-dependent stiffness, respectively. CONCLUSIONS:Load-dependent stiffness appears to act mainly via hypertension, whereas structural stiffness may reflect BP-independent vascular damage. Thus, combining BP control with vascular protection strategies may help prevent CVD.
